Reducing Drug Resistance Should be the Aim of Therapies

Review Article | DOI: https://doi.org/10.31579/2693-4779/028

Reducing Drug Resistance Should be the Aim of Therapies

  • P. D. Gupta 1

Former Director Grade Scientist, Centre for Cellular and Molecular Biology, Hyderabad, India.

*Corresponding Author: P. D. Gupta, Former Director Grade Scientist, Centre for Cellular and Molecular Biology, Hyderabad, India.

Citation: P. D. Gupta. (2021) Reducing drug resistance should be the aim of therapies. Clinical Research and Clinical Trials. 3(2); DOI:10.31579/2693-4779/028

Copyright: © 2021 P. D. Gupta, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 16 February 2021 | Accepted: 15 March 2021 | Published: 18 March 2021

Keywords: drug resistance; spectrum antibiotics; immunochemicals; microbiota

Abstract

Over the period, due to evolutionary constrains, gene mutations, changes in micro- and mega- environment gave a tool to bacteria to adopt for survival in the hostile environment. When they are exposed with broad spectrum antibiotics, they have adopted to live and become resistant to antibiotics. In this review many preventive and curative strategies has been described to avoid antibiotics. These lines of treatments would not give chances to microbes to become drug resistant. “Prevention is better than cure” adopting this strategy we have described immunochemicals and many herbal medicines which will prevent infections. Also given importance to maintain proper balance of microbiota in the gut by replacement of the lost (may be due to many reasons) species which are considered necessary for maintaining a balance in bacterial population.

Introduction

Omni present microorganisms can either be harmless to the host, or they can be highly Dangerous to the core that they can take away the life of the host [1]. Over the period, due to evolutionary constrains, gene mutations, changes in micro- and mega- environment these microbiota change their morphological features to suit the environment. Some scientists even conjecture their presence on other planets and even in space because of their property that they can grow at high temperature without even photosynthesis [2,3]. Bacteria are the best example to adapt and survive

In hostile environment [4]. A systems perspective is needed to help understand the complex host–bacteria interactions and their association with pathophysiological phenotypes so that alterations in the composition of the gut microbiota in disease states can be reversed [5 ,6] In addition to killing, antibiotics create imbalance between pathogenic and beneficial bacteria which causes more damage compared to fresh invasion of pathogens[5]. The need for novel antibiotics comes from the relatively high incidence of bacterial infection and the growing resistance of bacteria to conventional antibiotics [6]. Overuse of antibiotics have also created ‘SuperBugs’, because of these reasons antibiotic era is fast fading [7]. Consequently, new methods for reducing bacterial activity (and associated infections) are badly needed. More  and  more  antibiotics  becoming  useless;  many  bacterial  species  have  become  drug  resistant  because  of  overdose  of  these  drugs [7]. Not just because of only drug resistance, even imbalance of bacterial strains in microbiota can be the cause of serious health issues [5].  We must rebuild our defences against deadly bacteria by changing the strategise of the treatment; do we have any alternatives to existing antibiotics?

Approaches towards Elimination of Antibiotics

Now in order to avoid antibiotics generally 2 approaches have been adopted: Preventive and curative approaches. Immunochemicals and biologics. These are the products   that are produced from living organisms or contain components of living organisms. Types of biologic drugs include vaccines, blood, blood components, cells, allergens, genes, tissues, and recombinant proteins.  Antibody-based drugs offer new mechanisms of action and greater specificity. A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease [8]. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. A preventative vaccine is administered to a person who is free of the targeted infection. By introducing a part of the microbe or an inactive microbe (which acts like a decoy) into the body, the immune system reacts by producing antibodies. The most common and serious vaccine-preventable diseases tracked by the World Health Organization  are: diphtheria, haemophilus influenzae serotype b infection, hepatitis B, measles, meningitis, mumps, pertussis, poliomyelitis, rubella, tetanus, tuberculosis, and yellow fever.

The bacterial genetic material (DNA and / or RNA) is attacked by synthetic peptide-conjugated phosphorodiamidate morpholino oligomer (PPMO) (Genetical approach), or bacteria can be killed by specific viruses, or by restoration of missing components of the flora from fecal microbiota to balance the missing population and by recently developed [5,9].  Nanotechnologal approach where many types of nanoparticles and nanocomposites are used to target bacteria as an alternative to antibiotics [10]. Many traditional organic substances such as Manuka honey, tea tree and clove oil, and curcumin are also in vogue. Recently, researchers have found some alternatives to attack bacteria without using antibiotics [11].

Faecal transplants

Transplantation of faces from a healthy donor into another person to restore the balance of bacteria in their gut. Faecal transplants may help treat gastrointestinal infections causing severe diarrhoea and other conditions. A difficult-to-treat life-threatening bacterial infection of Clostridium difficile, also been treated with faecal,  most patients' symptoms went away within 48 hours of the procedure, In a 2013 study,[12] researchers processed donor faecal matter until it contained only bacteria that they could put in a pill, and found that the pills were well tolerated by patients with Clostridium difficile. Five out of nine patients who received faecal bacteria were cured immediately of their infections, compared to five of 11 in the group getting antibiotics. Three of the four remaining patients who got faecal bacteria then got antibiotics; two were cured within days [13-17].

Exercise

There are trillions of microscopic organisms in the gut that play a crucial role in our overall health and function of the body. During moderate exercise, immune cells circulate through the body more quickly and are better able to kill bacteria and viruses.  Cortisol and adrenaline, known as the stress hormones, raise blood pressure and cholesterol levels and suppress the immune system. Research showed that exercise also improves the gut bacteria. Exercise can change the composition of population of gut microbiome.

To measure the benefit of exercise against inflammation in the gut, Woods and colleagues performed the first exercise fecal microbiome transplant in mice and published the results in 2017. They took faecal matter from mice that exercised and those that didn’t and transferred the material into germ-free mice. Then, once the microbiota had established itself in the recipients, the team gave the animals’ drugs, inducing extreme inflammation in the colon. Mice that received gut microbes from active donor’s loss less body weight and had fewer symptoms of inflammatory disease compared with mice that received microbes from sedentary animals [18]. Whether a similar protocol could help people suffering from irritable bowel syndrome—marked by persistent inflammation—remains to be tested.

Therefore the exercise can be used as a treatment to maintain the balance of the microflora or to rebalance his eventual dysbiosis, thus obtaining an improvement of the health status. Nevertheless further studies are needed to fully understand the mechanisms that determine changes in the composition and functions of the microflora caused by exercise and all their related effects. Although exercise-altered microbiota could be an approach for the treatment of diseases associated with alterations of the intestinal microflora, very few studies have investigated the beneficial effects of exercise on the microflora composition in relation to disease [19].

Genetic approach

This approach is very effective.  The  bacterial  genetic  materi-al  (DNA  and/or  RNA)  is  attacked  by  synthetic  peptide-conjugated  phosphorodiamidate morpholino  oligomer  (PPMO)  [9].  This compound has been proved to be the bacteria’s new worst enemy; even superbug Clostridium difficile is killed by this newly synthesized compound. Unlike antibiotics, PPMO can silence specific genetic targets by disrupting the bacterial gene’s synthesizing capacity. Although, there is no issues about the efficacy of PPMO, issues of its toxicity need to be addressed  in  further  testing  before  it  can  be  used  in  humans.  The  mechanism  that  PPMOs  use  to  kill  bacteria  is  revolutionary  and  therefore bacteria can not develop resistance to this; as they have developed for conventional antibiotics [9].

Viral attack

Superbug Clostridium difficile is one of the natural microbes found in the gut, but chronic antibiotic use can make it go haywire. It’s also one of the many superbugs turning up at hospitals. It causes many deaths and hospitalizations among humans worldwide. Viruses that eat bacteria, to specifically target C. diff. They work by attaching to bacteria as a host, injecting their DNA-which replicates-and causing the bacterial cell to burst open. Researchers say these phages are effective against 90 percent of the most clinically relevant C.  Diff   strains in the United Kingdom. AmpliPhi is funding the development of these C. diff phages and hopes to have a mixture ready for clinical trials soon [20].

Phage therapy

Phages, short for bacteriophages, are bacteria-specific viruses that have been used as a treatment against pathogens with an estimated 1031-1032 phages in the world at any given time [2], they make up the most abundant biological entity on Earth and play a crucial role in regulating bacterial populations. Conventionally, phage therapy relies on the use of naturally-occurring phages to infect and lyse bacteria at the site of infection [21].

Phage therapy is widely being reconsidered as an alternative to antibiotics. Currently, bioengineered phages and purified phage lytic proteins specifically against multidrug-resistant bacterial infections are used,   as either an alternative or a supplement to antibiotic treatments.   Although much is still unknown about the interactions between phage, bacteria, and human host, the time to take phage therapy seriously seems to be rapidly approaching [22].

Figure 1: Showing various mechanism of action of bactericidal drugs for killing bacteria. Adopted from (Gupta and Asha, 7)

CRISPR Technology

A new CRISPR tool could be instrumental in preventing pathogenesis of human bacterial infections and plasmid-borne antibiotic resistance genes and virulence determinants. To achieve this system, researchers developed a proactive genetic system, or ProAG, that uses self-copying mechanisms to scrub antibiotic resistance. Plasmid-encoded antibiotic resistance determinants can be targeted by CRISPR gRNA/Cas9 systems in bacteria Genes conferring antibiotic resistance are often found on plasmids, circular forms of DNA that can replicate independently of the bacterial genome. Amplification effects of these plasmids can lead to the transfer of antibiotic resistance among bacteria. Recently Valderrama et al [23] .Have developed several cut-and-destroy methods but have had only moderate success with them. The system relies on a self-amplifying "editing" mechanism that increases its efficiency through a positive feedback loop. The success of this system is attributed to the precise insertion of the gRNA into the targeted cleavage site with appropriate cargo sequences, which reduced antibiotic-resistant colonies.

While Pro-AG is not yet ready for treating patients, a human delivery system carrying Pro-AG could be deployed to address conditions such as cystic fibrosis, chronic urinary infections, tuberculosis and infections associated with resistant biofilms that pose difficult challenges in hospital settings "It's possible that this attachment is a common feature in many type IV pili expressing enteropathogens such as Vibrio cholerae and constitutes a new therapeutic target against such bacterial pathogens."

Their research results will lead to the development of not only new vaccines for Enterotoxigenic E. coli (ETEC), but also anti-adhesion agents for preventing the binding of proteins implicated in bacterial attachment. Anti-adhesion agents can rinse pathogenic bacteria out from the body without destroying them, so there is no danger of producing drug-resistant bacteria. These agents, once developed, will act as a novel treatment approach that may serve as an alternative to antibiotics.

Nanotechnology

The need for novel antibiotics comes from the relatively high incidence of bacterial infection and the growing resistance of bacteria to conventional antibiotics. Consequently, new methods for reducing bacteria activity (and associated infections) are badly needed Nanotechnology may be particularly advantageous in treating bacterial infections. Nanoparticles (NPs) are increasingly used to target bacteria as an alternative to antibiotics. . The antibacterial mechanisms of NPs are poorly understood, but the currently accepted mechanisms include oxidative stress induction, metal ion release, and non-oxidative mechanisms. The multiple simultaneous mechanisms of action against microbes would require multiple simultaneous gene mutations in the same bacterial cell for antibacterial resistance to develop; therefore, it is difficult for bacterial cells to become resistant to NPs [24,25].

Many traditional organic substances

Long ago In Ayurveda herbal medicines were used in addition to some animal product and some minerals (ashes) to control all sorts of diseases [11]. They used the same herb for preventing as well curative purposes depending on doses. In the middle ages many infectious diseases were conquered through the discovery of antibiotics and antiviral agents. However, due to immergence of   the antibiotic-resistant strains and mutant microorganisms that are more powerful than the existing ones in recent times, again natural products have been as widely used as chemical drugs against   infectious diseases. However, since natural products are the by-products of empirical medicine, they lack scientific validation. Currently, various scientific experiments are being conducted to fill this gap by evaluating the efficacy of natural product [26,-28].

Manuka

honey is sometimes referred to as medicinal honey because it has a high antibacterial activity and has been shown to be good for wound healing and can help to relieve sore throats, mouth ulcers, sore gums and possibly indigestion," Debenham explained. Tea tree oil   is an essential oil distilled from the leaves of the native Australian plant Melaleuca alternifolia. In recent decades, its popularity has grown in other areas of the world as an alternative and complementary treatment. Today, tea tree oil is commonly found in cosmetics, topical medicines, and household products [29]. Tea tree oil is best known for its antibacterial, Anti-inflammatory and antifungal activity [30, 31]. Other research indicates that a type of bacteria associated with bad breath may be treated with tea tree oil and alpha-bisabolol, the active component in chamomile [32].

Fights infections

Traditionally Clove oil, has been used for easing digestive upset, relieving pain, and helping with respiratory conditions. Research has found that clove oil may have benefits for dental and topical applications, for treating infections, and even fighting cancer [33]. Blessed with a multitude of antiseptic properties, clove oil can be used to treat cuts, wounds, fungal infections, insect bites and even stings. However, direct application of clove oil may prove harmful. If the wound is too sore, it is advisable to dilute clove oil by adding almond or coconut oil. These carrier oils will prevent your sensitive skin from burns that can be caused by direct application of clove oil.

Curcumin

Turmeric and especially its most active compound have many scientifically-proven health benefits, such as the potential to prevent heart disease, Alzheimer's and cancer [34]. It's a potent anti-inflammatory and antioxidant and may also help improve symptoms of depression and arthritis. Turmeric and especially its most active compound curcumin have many scientifically-proven health benefits, such as the potential to prevent heart disease, Alzheimer's and cancer. It's a potent anti-inflammatory and antioxidant and may also help improve symptoms of depression and arthritis. 

Conclusions

Microorganisms are much simpler than human being, but Nature has given certain special features to them. Bacteria and other microorganisms divide rapidly, which increases the likelihood for higher mutation rate in turn when they are exposed to antibiotics there are fair chances to evolve antibiotic-resistant mutants. Resistance is multifaceted and therefore microorganisms   have ample opportunity to evolve and become resistant to entire antibiotic classes over the period. In addition, the misuse of antibiotics to treat viral diseases (e.g., the common cold) unnecessarily exposes patients and their bacteria to antibiotics and fails to treat the actual disease being experienced. This ease of access only increases exposure and subsequently the risk of resistance.  Broad-spectrum antibiotics: they kill not only harmful pathogens, but “good” bacteria that make up the microbiome within humans. Doing so results in the development of resistance in the target pathogen as well as the members of healthy microbiome, which can then transfer resistance to pathogens they encounter, further spreading the problem. Killing of the healthy microbiome has been linked not only to the development of Clostridium difficile diarrhea but also diabetes, obesity, immune defects, and antibiotic resistance spread through gene transfer

In order to resolve these issues, we have to avoid use of broad-spectrum antibiotics and adopt the Pathogen-specific strategies. Even before this, as discussed, we should give more stress to herbal medicines to prevent infections, this way we will be less exposed to antibiotics.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad